International Journal of Mycobacteriology最新文献

Background: Extrapulmonary tuberculosis (EPTB) constitutes 15%-20% of the entire tuberculosis (TB) cases worldwide. However, the lack of proper diagnostic methods, the absence of a reliable model system, and limited knowledge of its pathogenesis impair therapeutic efficacy and contribute to compromised treatment strategies. This study aims to evaluate the Mycobacterium marinum-murine infection model to study bone erosion induced by M. marinum and associated changes in the bone density and soft-tissue damage. A thorough understanding of the EPTB infection and the pathogenesis is necessary and requires a reliable in vivo animal model that mimics pathology similar to human infection.

Methods: All studies involved random, stochastically selected healthy, equal weight and activity of C57BL/6 inbred mice for all experiments. All control mice were mock-injected with sterile phosphate-buffered saline in place of the infectious agent and are maintained in isolators having the same light and dark cycles. At the indicated days postinfection, tail lesions are measure and taken for MicroCT as described.

Results: The M. marinum mice infection model presented here offers quantifiable pathological features as the infected tails exhibited infiltration of the immune cells, and the microcomputed tomography imaging showed bone erosion to the extent of the coccygeal vertebral loss. Infection of the mice with Isoniazid Resistant Population (IRP) and Ethambutol Resistant (EmbRP) of M. marinum also exhibited pathological features akin to wild-type M. marinum infection. At the same time, for EmbRP, the severity is significantly reduced.

Conclusions: These findings advocate the use of the murine model of mycobacterium to understand the EPTB, precisely bone and spine TB.

Findings from new methods have, during recent years, increased the knowledge of diseases in the past, good examples being tuberculosis (TB) and leprosy. Analyses of DNA and cell wall lipids have, in addition to osteology, been used to demonstrate these diseases in ancient bones. An old example of TB is from a bison existing in Wyoming, USA 17,000 years ago. TB has furthermore been shown in several ancient human skeletons, e.g., in a woman and a child who lived in the Eastern Mediterranean 9000 years ago and in humans who lived in East Asia and America before the arrival of the Europeans. These results indicate that TB was widespread in ancient times. Lipid studies support the hypothesis that TB bacteria originate from nonpathogenic mycobacteria in the environment. Several studies show that leprosy existed in Europe during the Middle Ages but does not seem to stretch back more than 2000 years. There are, however, osteological evidence indicating that leprosy was present in India over 4000 years ago. An interesting finding is that co-infections with both leprosy and TB have been demonstrated in several historical samples, i.e., a Viking grave.

Tuberculosis (TB) remains a global public health challenge, with an increasing incidence of extrapulmonary forms. Isolated muscular involvement is extremely rare, even in high-endemic regions. This study highlights an unusual case of muscular TB in a 24-year-old patient with no medical history, presenting with a painless swelling on the outer leg, without fever or other symptoms. Blood tests were normal, whereas imaging and biopsy initially suggested an infected hematoma. The culture of bacteriological samples on specific culture solid media confirmed the presence of Koch's bacillus. The patient was treated with drainage, lavage, and anti-TB therapy, showing significant clinical and radiological improvement after 6 months. TB should be included in the differential diagnosis for any unexplained soft-tissue swelling, particularly in individuals originating from regions where TB is endemic. To our knowledge, no cases of muscular involvement in the lateral compartment of the leg have been reported, making our case unique.

Background: Pulmonary tuberculosis (PTB) has a major global impact and has been reported as one of the most relevant complications in patients with systemic lupus erythematosus (SLE). The aim of this study was to analyze the bibliometric parameters of the scientific literature indexed in Scopus regarding the coinfection between PTB and SLE.

Methods: A bibliometric study was conducted using a search strategy with MeSH terms to identify articles indexed in Scopus. After screening, 122 articles were included in the study. Bibliometric tools (SciVal, VOSviewer, and Bibliometrix) were used to analyze publication metadata.

Results: Scientific production showed an annual growth rate of 4.56%, with a mean of 22.4 citations per publication per year. Rheumatology International, ranked in Q2, was the most relevant journal in the field of PTB and SLE, followed by Clinical Rheumatology and the Indian Journal of Tuberculosis. India demonstrated the greatest growth, with approximately 125 articles, whereas Brazil ranked fifth with sustained productivity. National collaboration was most frequent (46.7%); however, articles with international authorship achieved greater impact, with 209.8 citations per publication and 148% more citations than expected.

Conclusion: Scientific output on PTB and SLE has steadily increased over the past 20 years. India, China, and Brazil lead the field, with international cooperation playing an emerging but significant role. The main publication venues are journals ranked in Q2 and Q3.

Background: Drug-resistant tuberculosis (TB), especially rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), remains difficult to treat due to toxic aminoglycosides. The World Health Organization recommended all-oral bedaquiline-based regimens, but evidence comparing their effectiveness to injectable-containing regimens is limited. This study evaluated treatment success between both approaches.

Methods: This was a retrospective study, which included 114 adults aged 18 years and above with RR/MDR-TB treated at Kibong'oto Infectious Diseases Hospital with either a 9-11-month injectable-containing regimen from 2018 to 2019 or a modified all-oral bedaquiline regimen from June 2020 to May 2021. Patients were followed monthly for smear/culture conversion and clinical outcomes up to 12 months posttreatment. Analysis was performed using SPSS version 25.

Results: Of 114 patients, 71 (62.3%) received an all-oral bedaquiline-containing regimen. Overall, 80 (70.2%) patients were male, with a median age of 37 years (interquartile range: 29-48); 27 (23.9%) patients were human immunodeficiency virus infected, and 37 (22.5%) had prior TB treatment. Culture conversion at month 2 occurred in all 43 patients on injectable regimens, compared to 63 (90%) patients on all-oral regimens (P = 0.03). Treatment success was higher in the all-oral group at 63 (94.4%), compared to 33 (76.7%) in the injectable group (P = 0.001). Mortality was 7 (14.0%) in the injectable group and 4 (5.6%) in the all-oral group (P = 0.004).

Conclusion: All-oral bedaquiline regimens demonstrated higher treatment success and lower 12-month posttreatment mortality, while injectable regimens had faster culture conversion at month 2, but poorer overall outcomes, supporting the use of all-oral treatment.

Background: Nontuberculous mycobacterial lung disease (NTM-LD) is an increasingly serious chronic lung infection, especially in people with low immune function.

Methods: This study collected clinical inpatient data from January 2020 to December 2024 at the First People's Hospital of Yulin, aiming to evaluate the risk factors for nontuberculous mycobacterial (NTM) infection.

Results: A study involving 199 patients found that 143 (71.86%) were infected with Mycobacterium tuberculosis (MTB), whereas 56 (28.14%) were infected with NTM. The most common NTM species were Mycobacteroides abscessus, accounting for 53.57% (30/56), followed by Mycobacterium intracellulare at 10.71% (6/56). The NTM separation department mainly focuses on respiratory medicine, accounting for 80.36% (45/56) of cases. The median age of the patients is 60 years. The risk factors associated with NTM infection include age (45-65), autoimmune diseases, chronic obstructive pulmonary disease, bronchiectasis, concomitant pulmonary aspergillosis, and immunosuppressant use. Among these, bronchiectasis is an independent risk factor for infection (odds ratio [OR]: 7.357, 95% confidence interval [CI] 3.080-17.574). In addition, expectoration is a significant risk factor for rapidly growing mycobacteria (RGM) infection in NTM-LD (OR: 4.278, 95% CI 1.314-13.928).

Conclusions: Over one-third of patients suspected of having tuberculosis are actually infected with NTM, and those with bronchiectasis have a higher risk of NTM infection. The most common NTM-LD strain is M. abscessus, which is clinically associated with expectoration as a risk factor for RGM infection.

The Mycobacterium avium complex (MAC), consisting mainly of M. avium and Mycobacterium intracellulare, is a group of nontuberculous mycobacteria found in water, soil, and aerosols. While generally low in pathogenicity for immunocompetent individuals, MAC can cause severe infections in immunocompromised patients, such as those with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, organ transplants, or on immunosuppressive therapy. Although pulmonary infections are most common, extrapulmonary infections like spondylodiscitis are becoming important diagnostic and therapeutic challenges. This report describes a case of M. avium spondylodiscitis in a 79-year-old woman with a history of myelofibrosis, treated with ruxolitinib, and previous M. avium infection. The patient presented with fever and exacerbated bone pain, particularly in the lumbar spine and sacroiliac joints. Diagnostic imaging and microbiological analysis confirmed the diagnosis of spondylodiscitis caused by M. avium. Despite the initiation of appropriate antimicrobial therapy, including azithromycin, rifampicin, ethambutol, and amikacin, the patient developed severe acute respiratory failure and ultimately succumbed to respiratory distress, likely secondary to pulmonary edema from the infection. This case underscores the rarity and diagnostic complexity of M. avium-induced spondylodiscitis, particularly in immunocompromised patients. It highlights the critical need for early clinical suspicion, microbiological confirmation, and a multidisciplinary approach to treatment, including both pharmacological and surgical interventions when necessary.

Background: Anti-tuberculosis (TB) drugs are a common cause of hepatotoxicity. Hepatoprotective agents are often empirically used to prevent anti-TB drug-induced hepatitis (DIH). This study aimed to evaluate the incidence of DIH in new TB patients receiving hepatoprotective agents and identify associated risk factors.

Methods: A retrospective cross-sectional study was conducted on 140 new pulmonary TB patients at two hospitals in Makassar, Indonesia. The diagnosis of TB and DIH severity (based on World Health Organization criteria) was determined by pulmonologists. Data on demographics, comorbidities, time to DIH onset, liver enzyme levels such aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin were analyzed using Chi-square and paired t-tests.

Results: DIH was observed in 38 (27.1%) patients. It was more prevalent in females and individuals over 50 years. The majority of DIH cases were grade two, characterized by elevated AST (71.1%) and ALT (47.7%). Comorbidities, including diabetes mellitus (28.9%), human immunodeficiency virus (10.5%), and chronic kidney disease (2.6%), were significantly associated with a higher incidence of DIH (P < 0.001). The mean onset of DIH was within 14 days in 94.7% of cases. While AST and ALT significantly increased posttreatment (P < 0.001), bilirubin levels did not correlate with these increases. The administration of hepatoprotective agents was associated with a 73% reduction in DIH incidence.

Conclusion: Despite the use of hepatoprotective agents, advanced age and the presence of comorbidities significantly increase the risk of DIH in TB patients undergoing anti-TB treatment. These findings highlight the importance of careful monitoring and management of high-risk TB patients, even with hepatoprotective co-administration.

Background: The QuantiFERON-TB Gold Plus (QFT-Plus) assay, widely used for latent tuberculosis infection (LTBI) screening, includes two antigen tubes: TB1, which stimulates T-helper cells expressing CD4 (CD4⁺ T cells), and TB2, which additionally stimulates cytotoxic T cells expressing CD8 (CD8⁺ T cells). However, the added diagnostic value of CD8⁺ stimulation in TB2 remains uncertain. This study aimed to evaluate the diagnostic agreement between TB1 and TB2 responses in the QFT-Plus assay and assess whether TB2 provides a significant incremental benefit over TB1 in detecting tuberculosis infection across demographic and clinical subgroups.

Methods: This was a retrospective study that included individuals aged ≥14 years who underwent QFT-Plus testing. Interferon-gamma (IFN-γ) responses in TB1 and TB2 tubes were compared using the Wilcoxon signed-rank test. Qualitative concordance was assessed using Cohen's kappa coefficient. Subgroup analyses were stratified by age, sex, diabetes, and immunosuppressive therapy.

Results: Among 761 participants, median IFN-γ responses were slightly higher in TB2 than TB1 (0.21 vs. 0.19 IU/mL; median delta 0.02 IU/mL; P = 0.0002). This difference was consistent but small across most subgroups. Overall concordance between TB1 and TB2 qualitative results was 94.3% (Cohen's kappa = 0.868). Agreement remained strong across sex, age, and diabetes groups, though it was lower among users of tumor necrosis factor inhibitors (kappa = 0.582). No subgroup demonstrated a clinically significant added benefit of TB2 over TB1.

Conclusion: TB2 elicited slightly higher IFN-γ responses than TB1, but the small delta values and high concordance suggest limited additional diagnostic value in most populations.